Public health officials in New York and New Jersey are fighting a measles outbreak that has sickened dozens of people since November, most of them unvaccinated members of orthodox Jewish communities. The virus was traced to travelers from Israel, which is dealing with its own measles outbreak at the moment

So far, the outbreak has been relatively small because, despite gaps in what’s known as community immunity, the overall national vaccination remains high enough to prevent wide-scale epidemics such as the one that raged through parts of Europe this year. But Americans should be alarmed, nevertheless. The next measles outbreak — and there will be one — could be much worse.

That’s because immunization rates among U.S. school-aged children are — incredibly — declining in certain states, thanks to unreasonably permissive immunization rules. All but three U.S. states allow parents to opt out of vaccination requirements on religious grounds, and 18 of them allow exemptions based on what they call personal belief, which is an even less strict standard. That’s become a problem in recent years as the gospel of ignorance being pushed by the “anti-vax” movement has gained traction across the country. Many vaccination opponents believe the medicine in vaccinations for measles, mumps, rubella and other real diseases causes autism and various “vaccination injuries.” They have no science to back this up, only misinformed anecdotes that serve to scare gullible parents.

And they’re gaining ground. A study published earlier this year found that nonmedical exemptions have been on the rise in 12 of the 18 states that allow personal belief exemptions. The World Health Organization attributes a global spike in measles in the last two years to the spread of misinformation by those opposed to vaccinations.

Happily, California has gone the other way — tightening its immunization requirements. California is one of only three states that allow neither religious nor personal belief exemptions. A serious measles outbreak in 2014 that was traced to Disneyland brought attention to the state’s declining immunization rates, particularly in communities where the anti-vax fears had taken root.

That outbreak was scary, but it served as a wake-up call to California lawmakers, who just months later banned all exemptions for vaccinations except those for medical reasons. Childhood immunization rates immediately rebounded statewide, reaching 95% for the first time in decade, including in school districts where rates had dropped the most precipitously.

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Opposition to mandatory vaccination in California continues, however. When personal belief and religious exemptions were banned, medical exemptions increased. The rise is still too small to impact overall rates of protection, but it is a trend that bears watching.

It’s frustrating that some parents are more concerned about protecting their children from imaginary threats than from a well-documented killer. Measles is nothing to mess around with; it is extremely contagious, in part because sick people can infect others before they realize they are suffering from more than the sniffles. And it can be particularly deadly for unvaccinated adults. Before a vaccination was developed in the 1960s, about 2.6 million people died from measles every year, according to the World Health Organization.

No one has died yet in this particular East Coast outbreak. That’s a relief. But it shouldn’t take death to wake the public to the fact that the rhetoric behind anti-vaccination arguments has real and terrible consequences.

There’s been an uptick in swearing among candidates for president. If it’s a strategy to attract younger and less religious voters, it may backfire partly because the profanity the candidates use may not have much impact.

Overcoming opposition from companies making high-interest loans, the state Legislature was poised to give final approval Friday to a bill to cap interest rates on installment loans between $2,500 and $10,000.